Quality standard
Quality statement 1: Pre-pregnancy advice for women with treated hypertension
Quality statement 1: Pre-pregnancy advice for women with treated hypertension
Quality statement
Women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy.
Rationale
Information can be provided to women who may become pregnant about safe antihypertensive treatment during pregnancy as part of an annual review of hypertension care. Women should be informed about potential risks, including the risk of congenital abnormalities, linked to particular antihypertensive drugs. This should enable women to arrange a discussion with the healthcare professional responsible for managing their hypertension about alternative antihypertensive treatments if they are planning pregnancy or become pregnant.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy.
Data source: Local data collection.
Process
Proportion of women who have had treated hypertension for 12 months or longer who received information about safe antihypertensive treatment during pregnancy in the past 12 months.
Numerator – the number of women in the denominator who received information about safe antihypertensive treatment during pregnancy in the past 12 months.
Denominator – the number of women of childbearing potential who have had treated hypertension for 12 months or longer.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that systems are in place to give women of childbearing potential with treated hypertension information annually about safe antihypertensive treatment in pregnancy.
Healthcare professionals give information annually to women of childbearing potential with treated hypertension about safe antihypertensive treatment in pregnancy.
Commissioners ensure they commission services that give information annually to women of childbearing potential with treated hypertension about safe antihypertensive treatment in pregnancy.
Women who are having treatment for hypertension (high blood pressure) and who may become pregnant are given information annually about safe treatment for high blood pressure during pregnancy.
Source guidance
Hypertension in pregnancy: diagnosis and management. NICE guideline NG133 (2019), recommendations 1.3.2, 1.3.4 and 1.3.5
[The 12-month timeframe is not derived from the NICE guideline on hypertension in pregnancy. It is considered a practical timeframe to enable stakeholders to measure performance]
Definitions of terms used in this quality statement
Safe antihypertensive treatment
Women taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) should be provided with information to advise that there is an increased risk of congenital abnormalities if these drugs are taken during pregnancy, and discuss alternative antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy. The Medicines and Healthcare products Regulatory Agency (MHRA) drug safety update on ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy states 'Use in women who are planning pregnancy should be avoided unless absolutely necessary, in which case the potential risks and benefits should be discussed'. If ACE inhibitors or ARBs are being taken for other conditions such as renal disease, alternative treatment should be discussed with the healthcare professional responsible for managing their condition.
Women taking thiazide or thiazide-like diuretics should be provided with information to advise that: there may be an increased risk of congenital abnormality and neonatal complications if these drugs are taken during pregnancy, and to discuss alternative antihypertensive treatment with the healthcare professional responsible for managing their hypertension, if they are planning pregnancy.
Women who take antihypertensive treatments other than ACE inhibitors, ARBs or thiazide or thiazide-like diuretics should be provided with information to advise that the limited evidence available has not shown an increased risk of congenital malformation with such treatments. [NICE's guideline on hypertension in pregnancy, recommendations 1.3.2 to 1.3.5]
Treated hypertension
Hypertension that is treated with 1 or more antihypertensive drug. [Adapted from NICE's full guideline on hypertension in pregnancy]
Equality and diversity considerations
'Childbearing potential' should be determined for women on an individual basis. Access to information about safe antihypertensive treatment during pregnancy should not be determined solely by age, because childbearing potential is also dependent on factors other than age.
Where information is provided, there must be equal access to information for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or advocate if needed.
For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.